<!DOCTYPE html>
<html>
<head>
	<meta charset="utf-8">
	<meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0">
	<meta name="apple-mobile-web-app-capable" content="yes">
	<meta name="apple-mobile-web-app-status-bar-style" content="black">
	<meta name="format-detection" content="telephone=no">
	<title>提交信息</title>
	<link rel="stylesheet" type="text/css" href="{php echo IMS_VERSION>=0.6?"../addons":"./source/modules"}/bm_floor/template/images/index.css" media="all">
	<script>
		{if $success}
			alert('提交成功，请您及时兑奖！');
			{if $url<>''}
			window.location.href="{$url}" 
			{/if}
		{/if}
	</script>	
</head>
<body id="wrap">
	<div class="cardexplain">
		<!--intro-->
		<form method="post" action="" id="form" onsubmit="return check_submit(this)">
		<input type="hidden" name="token" value="{$_W['token']}" />
		<input type="hidden" name="from_user" value="{$from_user}" />  
		<input type="hidden" name="rid" value="{$rid}" />	
		<input type="hidden" name="url" value="{$url}" />	
			<ul class="round">
				<li class="title mb"><span class="none">请填写以下信息</span></li>
				<li class="nob">
					<table class="kuang" border="0" cellpadding="0" cellspacing="0" width="100%">
						<tbody>
							<tr>
							<th>姓名</th>
								<td>
									<input class="px" placeholder="请输入姓名" id="realname" name="realname" value="{$user['realname']}" type="text" maxLength="20" required>
								</td>
							</tr>
						</tbody>
					</table>
				</li>
				<li class="nob">
					<table class="kuang" border="0" cellpadding="0" cellspacing="0" width="100%">
						<tbody>
							<tr>
							<th>手机</th>
								<td>
									<input class="px" placeholder="请输入手机号" id="mobile" name="mobile" value="{$user['mobile']}" type="text" pattern="[0-9]{11}" maxLength="11" required>
								</td>
							</tr>
						</tbody>
					</table>
				</li>
				<li class="nob">
					<table class="kuang" border="0" cellpadding="0" cellspacing="0" width="100%">
						<tbody>
							<tr>
							<th>QQ</th>
								<td>
									<input class="px" placeholder="请输入QQ号" id="qq" name="qq" value="{$user['qq']}" type="text" pattern="[0-9]{5,15}" maxLength="15" required>
								</td>
							</tr>
						</tbody>
					</table>
				</li>
			</ul>
			<div class="footReturn" style="text-align: center;">
				<input style="margin: 0px auto 20px; width: 90%;" class="submit" value="提交" name="submit" type="submit">
			</div>
		</form>
	</div>
</body>
</html>
